WHO pandemic reviewers field comments on preview report

Mar 28, 2011 (CIDRAP News) – The independent committee reviewing the World Health Organization's (WHO's) performance during the 2009 H1N1 pandemic today at a meeting in Geneva received feedback from countries and organizations on its preliminary report, which was released Mar 10 and generally defended the WHO's actions. The feed back mostly consisted of questions and clarifications.

Today was the pandemic review committee's fourth and final public session. The group, which first convened in April 2010, will meet in closed-door sessions over the next 2 days to discuss today's comments, along with other verbal and written comments that it has received since it released the findings.

Dr Harvey Fineberg, the committee chairman, said at a press conference today that the panel will consider the feedback while preparing the final version, due in May in time for the World Health Assembly. The preview document included three principal conclusions and 15 recommendations on how the WHO can improve its future pandemic response. The reviewers' other task was to assess how the International Health Regulations (IHRs) functioned during their first use in an international health emergency.

Overall, the preview report defended the WHO against criticism that it overstated the pandemic threat, and it rejected critics' claims that the agency rushed to declare a pandemic in order to benefit vaccine manufacturers. But the panel also made several suggestions, such as improving methods for appointing the emergency committee and defining terms to describe pandemic severity.

Fineberg told reporters that the review committee heard between 12 and 20 presentations today at the plenary session. "A number of observers commented in support of some or all of the recommendations," he said, adding that the group welcomed those comments, but is focusing now on the criticisms and questions as it crafts the final report.

For example, presenters had questions about balancing vaccine distribution with virus sharing, pharmaceutical company liability in settings where countries received donated vaccine, and how prepositioned lines of credit for emergencies will be handled.

Another topic that came up in the comments was the panel's recommendation that member states consider wider use of seasonal flu vaccination as a tool to build capacity for pandemic vaccine production, Fineberg said. He said a commenter raised a concern that relying too heavily on the pandemic vaccine capacity rationale might weaken confidence in the benefits of seasonal flu vaccination and emphasized that seasonal flu vaccination should stand on its own merits.

One reporter asked Fineberg why the group advised that the WHO strengthen its conflict-of-interest notification procedures, even though it found no evidence of malfeasance.

"We recommended that more in the spirit of good practice and prevention than as a remedy for an error in the past," Fineberg said.

The review committee will also take into account WHO Director-General Dr Margaret Chan's comments to the group today, especially her view of obstacles to getting donated vaccine to developing countries, he said. "Everyone recognized that it remains a very serious impediment to the world's ability to deal with a future pandemic."

Chan said the WHO welcomed the preview document and has prepared a written response for the committee to consider. However, she added that some of the recommendations will be far easier to implement than others. "More difficult to address are weaknesses in the pandemic response that lie outside the direct authority and beyond the direct influence of WHO," she told the group. The text of Chan's comments was posted on the WHO's Web site.

For example, she said the preview report cites difficulties in supplying donated vaccines to developing countries in a timely manner. Chan, who said she was directly involved in efforts to get vaccine to developing countries, acknowledged that it didn't happen fast enough, but vigorously defended the WHO's actions.

"In all sincerity, WHO could not have tried harder, devoted more energy and staff to this task, or acted with a greater sense of urgency," she said, adding that hurdles included a lack of harmonization for registering medications and vaccine, vaccine company liability, sovereign rights to approve medical products, and availability of cold-chain capacity.

Chan said the group's finding that the world is unprepared to respond to a severe pandemic or other major public health emergency takes on added meeting given Japan's earthquake and nuclear disasters, as well as political upheaval in the Middle East and the Ivory Coast.

"In such a context, recommendations to improve the capacity of WHO and the international community to respond to public health emergencies take on added urgency," she said.